Organization Active NPI

Glendale Medical Group LLC

  • General Practice Physician
  • Phoenix, AZ
National Provider Identifier
1942776323
Registry record updated Feb 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
GLENDALE MEDICAL GROUP LLC
Practice address
9971 W Camelback Rd Ste 105
Phoenix, AZ 85037-5011
Phone
(480) 306-7227
NPI assigned
Oct 23, 2018
Last updated
Feb 12, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Michael Cormier, DCNPI 1851499057
Title
Authorized Official
Phone
(480) 306-7227

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X NU Primary

Addresses

Primary practice location

9971 W Camelback Rd Ste 105
Phoenix, AZ 85037-5011

Mailing address

4432 N Miller Rd Ste 102
Scottsdale, AZ 85251-3697
Phone (480) 306-7227

National Provider Directory

National Provider Directory

Locations

9971 W Camelback Rd
Ste 105
Phoenix, AZ 85037
Phone (480) 306-7227

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1540252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707696000000",
    "number": "1942776323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4432 N MILLER RD STE 102",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852513697",
            "telephone_number": "480-306-7227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9971 W CAMELBACK RD STE 105",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850375011",
            "telephone_number": "480-306-7227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLENDALE MEDICAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-23",
        "last_updated": "2024-02-12",
        "certification_date": "2024-02-12",
        "status": "A",
        "authorized_official_last_name": "CORMIER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "480-306-7227",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.